Background: Excessive iodine intake may have adverse effects on the thyroid, particularly in children, but the safe upper iodine intake concentration in children is unclear. Objective: We assessed the adverse effects of high iodine intake from iodine-rich drinking water on thyroid size in children by examining associations between thyroid volume (Tvol), total goiter rate (TGR), and iodine intake. Design: In a multistage cross-sectional survey, we collected two 24-h urine samples on 2 nonconsecutive days and determined 24-h urinary iodine excretion, then calculated habitual daily iodine intake. Ultrasonographic Tvol was measured, and TGR was calculated based on international and Chinese reference ranges for Tvol in children.Results: This study included 2089 children from Shandong province, where the median (IQR) drinking water iodine concentration was 183 mg/L (69-406 mg/L). The median (IQR) 24-h urinary iodine concentrations for the 2 collections were 381 mg/L (203-649 mg/L) and 398 mg/L (202-687 mg/L), respectively. The median (IQR) habitual daily iodine intake of children was 298 mg/d (186-437 mg/d). Tvols were slightly higher in boys than in girls (P = 0.035). The overall TGR was 9.7% and did not differ by sex. The TGR was w5% for children aged 7-10 and 11-14 y at iodine intakes of 200-249 and 250-299 mg/d, respectively. With the use of logistic regression and 2-step linear regression, a nonlinear association was observed between Tvol, TGR, and iodine intake, with a threshold intake of 150 mg/d. Conclusions: Tvol begins to increase in children when iodine intake is $150 mg/d, and the TGR exceeds 5% when daily iodine intake is $250 mg/d for children aged 7-10 y and $300 mg/d for children aged 11-14 y. Our findings suggest that 150-249 and 150-299 mg/d seem to be safe upper iodine intake ranges for children aged 7-10 and 11-14 y, respectively. This trial was registered at clinicaltrials.gov as NCT02915536.Am J Clin Nutr 2017;105:228-33.

The 24-h UIC was more accurate and reproducible than the MUIC in evaluating iodine status in a large-scale population study of school-age children.

Estimated 24-h UIE by UI/Cr ratio from spot urine could represent a valid and reliable alternative for measured 24-h UIE in estimating iodine excretion in children.

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